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Subject: Big Suprise
Date: 25 Sep 1995 16:10:21 +0100
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Electroshock debate continues skeptics cling to old images,
Sunday, September 24, 1995
By Andrew Fegelman
Unbeknownst to her, Lucille Austwick became the poster girl for
patient-rights advocates and psychiatry's skeptics.
"The Rosa Parks of electroshock" is how one publication described
the 82-year-old retired telephone operator, a patient in a North
Side nursing home.
Across the country, psychiatrists closely monitored her court case
in Chicago. It examined whether Austwick, without her consent,
could be given electroshock therapy to try to lift her out of
depression that had caused her to stop eating. Psychiatrists
believed that a ruling preventing the treatment would represent a
serious setback for electroshock.
Ultimately, Austwick never received the treatment after doctors
concluded that her condition had improved. But her case, and an
Illinois Appellate Court ruling earlier this month prohibiting the
treatment even after Austwick no longer needed it, has crystallized
one of the most controversial and unusual debates in psychiatry.
Critics call it shock treatment. Doctors prefer the more benign
"electroconvulsive therapy," or ECT. It is the administration of
electrical charges to the brain to treat mental disorders, usually
It isn't the first line of psychiatric treatment, but neither is it
infrequently used. Experts estimate that 50,000 to 70,000
electroshock treatments are administered annually in the United
Electroshock first was deployed to treat mental illnesses in 1938.
And for decades, controversy has surrounded its use, misuse and
associated problems, ranging from broken bones to death.
While psychiatrists say techniques have vastly improved over the
decades, the image of electroshock remains unsettling for many
There is R.P. McMurphy, the character played by Jack Nicholson in
the film version of "One Flew Over the Cuckoo's Nest," undergoing
doses of electricity to render him docile.
And then there is a humbled U.S. Sen. Thomas Eagleton (D-Mo.),
bumped out as George McGovern's vice presidential running mate in
1972 after shamefully confessing to receiving ECT in the way a
politician would admit marital infidelity.
Those lingering images have aided a movement that has continually
battled to discredit electroshock.
One of the movement's soldiers is David Oaks, a community activist
who runs the 1,000-member Support Coalition in Eugene, Ore.
The group bills itself as a patient-rights organization, but the
tone of its pleadings have been decidedly anti-electroshock.
"The claims seem to be that anyone who would criticize psychiatry
must be under the powers of some evil cult, and that is
ridiculous," Oaks said. "What we are is pro-choice, that people get
a range of alternatives, and that no force be used."
Oaks said his organization was attracted to Austwick's case by the
question of whether electroshock could be used on a woman who never
had consented to it.
To the dismay of psychiatrists, the group was allowed to file a
brief in the Austwick case describing problems with electroshock.
The guru of the anti-electroshock movement is Dr. Peter Breggin, a
Breggin once likened the treatment to a "blow to the head," saying
it delivered the same kind of brain damage.
But most psychiatrists dismiss electroshock opponents as kooks and
zealots. There is no better evidence, they say, than the fact that
among the leaders of the anti-electroshock movement is the
anti-psychiatry Church of Scientology and its Citizens' Commission
on Human Rights.
"A lot of these groups aren't just against ECT, they are against
psychiatry in general," said Dr. Richard Weiner, an associate
professor of psychiatry at Duke University and chairman of the
American Psychiatric Association's task force on electroshock.
"ECT has been the subject of a lot of public hearings, and it has
always come out OK," Weiner said.
Still, no one can dismiss the successes of electroshock's critics.
Their pinnacle came in 1983, when they pushed through a ban on
electroshock within the city limits of Berkeley, Calif. The ban was
later overturned in court.
But the legacy has lingered. California continues to have one of
the toughest electroshock laws in the country, requiring full
disclosure to the patient of reasons for the treatment, its
duration and all possible side effects.
Illinois law requires court approval of the treatment when the
patient isn't able to consent to it.
That's how Austwick's case ended up in court.
But it became more than a case about her, creating an arena for
much broader questions about the treatment in general. And it may
have resulted in a serious setback to use of electroshock.
It wasn't supposed to be this way. During a hearing before the
Appellate Court in May, Judge Thomas Hoffman warned that the
Austwick matter was not supposed to be a case about the pros and
cons of electroshock.
Instead, he said, the issue was whether Austwick should have been
given the treatment and what standards should be applied for
answering that question, the judge said.
Although Austwick no longer needed the treatment, the Appellate
Court decided that the precedent-setting case raised too many
critical issues. It issued a ruling anyway saying shock therapy
wouldn't be in Austwick's best interests.
The court noted the "substantial risks" associated with the
treatment, including broken bones, memory loss and even death.
The ruling reflected the thinking of the opponents, and the
Illinois Psychiatric Association criticized it for ignoring all the
The use of anesthesia and muscle relaxants, psychiatrists said,
have eliminated the incidence of broken bones.
As for memory loss, they conceded that it does occur but usually
Some patients, however, report some long-term memory loss that
Psychiatrists also note that statistics show a death rate of only
1 for every 10,000 procedures performed.
Some doctors say the Austwick case illustrates the dangers of the
courts trying to deal with science.
The Austwick ruling presented "not a very clear and fair
description of a treatment that is really life-saving," said Dr.
Philip Janicak, medical director of the Psychiatric Institute at
the University of Illinois at Chicago.
"It is rooted more in impressions that go back 20 years than the
facts about what modern techniques are involved."